State Residential Care and Assisted Living Policy: 2004. Provisions for Residents with Alzheimer's Disease and Dementia

03/31/2005

Forty-four states have specific regulatory provisions for facilities serving people with Alzheimer's disease and other dementias, an increase from 36 in 2002 and 28 in 2000. Examples of state activities regarding dementia care and the regulations for facilities serving residents with dementia follow.

Rhode Island requires a license for dementia care when one or more resident's dementia symptoms affect their ability to function as demonstrated by behaviors that adversely impact the rights of others; elopement; or an inability to self-preserve. Facilities that advertise or represent special dementia services or that segregates residents with dementia also need a license for dementia care. In addition to basic license requirements dementia care licenses require staff training specific to dementia care; a RN on staff and available for consultation at all times; and a secure environment appropriate for the resident population.
Pennsylvania has drafted rules that contain provisions for securing units and providing adequate indoor and outdoor wandering space. They also specify competency-based training requirements for administrators and staff covering mandated topics such as the definition and diagnosis of dementia, differences between dementia, delirium, and depression, managing behavioral symptoms, and working with family members.
Montana created a new licensure category for facilities that serve residents who are not capable of expressing their needs or making basic decisions. Requirements include staffing provisions; general staff education, training, and experience requirements; dementia specific annual continuing education requirement, including the teaching of skills necessary to care for, intervene and direct residents who are unable to perform ADLs; and techniques for minimizing challenging behavior. Other requirements apply to locked units or distinct parts of facilities.
Washington revised its regulations to require staff with experience and training in dementia care to coordinate outside services, offer monthly educational and family support meetings, and advocate for residents. Staff training requirements include a minimum of 30 hours on care for residents with dementia; nature, stages, and treatment of the disease; therapeutic interventions; communication techniques; medication management; therapeutic environmental modifications; assessment and care planning; the role of family and their need for support; staff burn-out prevention; and abuse prevention. Eight hours of continuing training is required annually.

Staff must be able to provide 2.25 hours of direct care per resident per day. At least two staff must be present for units serving more than five residents. An RN must be available if residents require nursing procedures. The rules describe special requirements for the physical environment with security measures, including secured outdoor spaces.

Licensed facilities that do not market themselves special care units but serve residents with early symptoms of dementia must provide staff training on dementia care, including strategies to help residents manage their behaviors.

Disclosure
- Twenty-four states have disclosure requirements for facilities that advertise themselves as operating special care facilities or units, or that care for people with Alzheimer's disease or other dementias. These facilities are required to describe in writing how they are different from other facilities. The regulations may require a description of the philosophy of care, admission/discharge criteria, the process for arranging a discharge, services covered and the cost of care, special activities that are available, and differences in the environment. See Table 1-5 for an overview of disclosure requirements. Specific examples of regulations regarding disclosure requirements follow.
  - California has a voluntary disclosure process for facilities offering special services for people with dementia. The state developed a consumer's guide that alerts family members to key questions that should be asked when seeking residential care for people with dementia. They include how the program meets the needs of people with Alzheimer's; the facility's pre-admission assessment process; the transition from the individual's current living arrangement to residential care; the care and activities that will be provided; staffing patterns and the special training received by staff.
  - Illinois' standard disclosure form, which all providers must use, addresses the form of care or treatment; philosophy; admission and retention policies; assessment care planning and implementation guidelines; staffing ratios; physical environment; activities; family members' roles; and the cost of care.
  - Minnesota adopted disclosure requirements in 2001, which require facilities to provide information about the form of care or treatment; the treatment philosophy; unique features for screening, admission and discharge; assessment and care planning; staffing patterns; the physical environment; security features; type and frequency of activities; opportunities for family involvement; and the costs of care.
  - Texas requires a disclosure statement that describes the nature of the care or treatment provided the pre-admission and admission processes, discharge and transfer policies, the planning and implementation of care, policies related changes in residents' condition, staff training on dementia care, the physical environment, and staffing.

Staffing and Training

Thirty-six states have requirements for dementia specific training and staffing for facilities serving people with Alzheimer's disease and other dementias. Examples follow.

In Alabama, staff in specialty care facilities must complete a training program developed by the Department of Mental Health and Mental Retardation and receive six hours of ongoing training a year on topics specified in the regulations.
Arizona requires staffing ratios of one staff per six residents during the morning and evening, and one per twelve residents at night.
Indiana requires six hours of training for direct service workers within 6 months of employment and three hours annually.
Rhode Island requires new direct service workers to receive at least twelve hours of orientation and training about dementia, communicating effectively with dementia residents, and managing problem behaviors. The state also requires that a RN be available to residents on site as needed, and available for consultation at all times.
Massachusetts, Nevada, and Oklahoma require 24-hour coverage by awake staff.

TABLE 1-5. Comparison of Disclosure Requirements
Topics Required	AR	CA	CO	DE	FL	GA	ID	IL	KY	MD	ME	MI	MN	MO
Philosophy	X	X		X		X	X	X		X	X		X	X
Services	X					X		X		X			X	X
Cost				X		X			X	X		X
Population served	X	X		X			X
Admission and discharge process	X	X		X		X	X	X		X	X		X	X
Assessment and care planning process	X	X		X				X		X	X		X	X
Staffing	X	X		X		X	X	X	X	X	X		X	X
Training	X	X		X		X	X	X	X	X	X			X
Physical environment	X	X		X		X		X		X	X		X	X
Resident activities	X	X		X		X					X		X	X
Family role	X			X		X		X			X		X	X
Psychosocial services				X
Nutrition				X
Form of care								X					X
Security features							X					X
Other			X		X
Topics Required	MT	NH	NJ	NC	OH	OK	OR	PA	RI	SC	TX	VT	WA	WV
Philosophy	X			X	X	X	X		X			X		X
Services	X			X				X						X
Cost				X	X	X	X	X	X	X		X		X
Population served												X
Admission and discharge process	X			X	X	X	X	X	X	X	X
Assessment and care planning process	X			X	X	X	X		X	X	X			X
Staffing	X			X		X	X		X	X	X	X		X
Training	X			X	X				X	X	X	X		X
Physical environment	X			X	X				X	X	X			X
Resident activities	X			X	X				X	X				X
Family role	X			X	X				X	X
Psychosocial services														X
Nutrition
Form of care					X			X	X	X	X
Security features
Other		X		X		X		X					X

State Residential Care and Assisted Living Policy: 2004. Provisions for Residents with Alzheimer's Disease and Dementia

Similar content

Disclosure

Staffing and Training